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Diets Don’t Work, But…

Brain: How are we going to get the earth to lose weight?Pinky: I know! We can get everyone to go on a diet!Brain: Diets don’t work, Pinky.Pinky: Not even if you call them “a whole new way of eating”?Brain: No.

Since it’s apparently Picking on My Heroes Week*, I’ll point you to the comments thread on this post at Feministing. The post itself, reporting on a recent study that (*cough* like a zillion others *cough*) concluded dieting does not lead to long-term weight loss or health gains, is great. And I probably shouldn’t even pick on the commenters, since at least when it’s a bunch of liberals, no one’s going down the “Obese people cost society money!” path. (Yet.) But still, it’s even more frustrating to see the usual shit here, not just on a liberal site but a feminist** site, than it is to see it, you know… everywhere else in the fucking world.

Said usual shit can be summed up thusly: “Diets don’t work, but…” Fill in the blank with any of the following–or make up your own!

Diets don’t work, but Weight Watchers, which is not a diet, works.

Diets don’t work, but “lifestyle changes,” which are not diets, work.

Diets don’t work, but restricting calories for the rest of your life, which is not a diet, works.

Diets don’t work, but cutting out carbs, which is not a diet, works.

Diets don’t work, but eating only whole foods, which is not a diet, works.

Diets don’t work, but reducing fat intake, which is not a diet, works.

Diets don’t work, but “portion control,” which is not a diet, works.

Diets don’t work, but eating right and exercising, which is not a diet (and clearly not something anyone’s ever thought of before!), works.

Gosh, there’s so much conflicting information here! However to synthesize it? Do you suppose there’s, like, a single element common to all those statements?

Ooh! Ooh! I see it! DIETS DON’T WORK.

What do I win?

The thing that causes so much confusion (to put it charitably) here is that diets do work, actually–in the short term. All diets, from cabbage soup to Weight Watchers, will cause people to lose weight. At first. But after five years, all diets have the same result: the vast majority of people who lost weight at first gained it back.

This is what people mean when they say, “Diets don’t work,” without adding a “but…” Diets do not lead to permanent weight loss for the vast majority of people. A slightly more efficient way of saying that is, “Diets don’t work.” But boy, people come out in droves to argue that one.

When I posted the Mastiff/Pug before and after shots the other day, I totally slayed myself when I remembered to add “Results not typical” under the pug. If you’ve ever looked at a commercial weight loss program’s literature, you’ve seen that phrase under every picture of a triumphant former fatty showing off her new self. Translation: “Hi! To indemnify ourselves against the world’s largest class action suit, we want to make sure you’re aware that our product does not work for most people! Now look back up at that picture! Don’t you want to look like her? Buy our product!”

It’s easy to ignore that pesky little point about the product not working, because hey, I’m not typical, either! I’ve got the resolve! I’ll be the one in the ad.

Fun fact: I have been asked by Jenny Craig staff if they could send my before and after photos to Corporate to see about making me the one in the ad on two separate occasions, years apart. I’m actually not typical! Except… Two different befores, two different afters. I’ll leave you to sort out what that means.

Nobody from Weight Watchers ever asked me, because I just used their online tools and never spoke to a human being about my weight loss, but if I’d been interacting with WW staff, I strongly suspect I would have been approached about doing ads there, too. I was not typical three times on two programs! I am the fucking queen of not typical!

Five years after the latest after, I look very like the befores again. Huh.

And okay, can we talk about how “Weight Watchers is not a diet, but a lifestyle change”? (Which, my god, must be the most brilliant marketing meme in history). Can we talk about “lifestyle changes” in general?

Here’s the big secret, which I have absolutely no scientific evidence to support but would nevertheless bet every cent I have, both my dogs, and my firstborn on: at least 95% of people who insist that “lifestyle changes” work (and who are not in the business of selling weight-loss products) are less than five years out from the beginning of a “lifestyle change.”

Better known, as they will see by the end of five years, as a “diet.”

As anyone who knew me between 1995 and 2002ish, but especially my sisters, can attest, I was fucking insufferable with my endless proselytizing about “lifestyle changes.” If I’d been more internet-savvy at the time, I totally would have been polluting every conceivable message board with my endless rambling about how easy it is, really, once you get used to it–once you’ve made that lifestyle change! About how much better it feels to be thin! About how I’ve taken control of my eating, my life, my destiny! About how I’m never, ever, ever going back!

And boy, would I feel like an asshole now. Specifically, a fat asshole.

Diets do not lead to permanent weight loss for the vast majority of people. Not even if you call them “a whole new way of eating.” Or a “lifestyle change.” If your lifestyle change involves putting restrictions on your food intake, you will almost certainly be fat again in five years.

Every study that looks at dieters five years down the line results in this conclusion. That’s why most studies don’t. Huge kudos to the UCLA researchers both for following up and stating that conclusion in no uncertain terms.

Well, except for the one who the Reuters article reports is now “planning to study whether exercise is the key factor leading to sustained weight loss.” Should be an interesting study, seeing as it will necessarily involve finding a large number of people who have achieved sustained weight loss.

My prediction: that study will conclude their secret is a daily dose of powdered unicorn horn.

*I should note here that the Shakesville issue has been completely resolved for me via respectful discussion. What a friggin’ concept.

**Because feminism is so totally about telling groups of people, women in particular, that their decisions about their own bodies are both wrong and everybody else’s business.

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79 thoughts on “Diets Don’t Work, But…”

I love this. I just love it! It made me laugh and nod my head repeatedly. That euphemistic phrase ‘lifestyle change’ just gets soooo much up my nose. I’m glad I made your virtual acquaintance after your proselytizing phase!

I just started and quickly ended a diet when I realized it was a set up – I had set myself up to feel less than because I was fatter than I wanted to be. Now I’m coming to terms with the fact that I’m gonna have to accept my fat – it reminds me of when I realized that I was a socialist, like “Oh, man, and I was trying so hard to fit in!”

When I was ‘thin’, I didn’t get more friends, accolades, or anything. In fact, I was weepy and tired all of the time. My teeth were loose. I was unhealthy and thin. Luckily I’m fat and healthy again and being within 3 years of a large loss I am finally coming to terms with the fact that yes, I’m COMPLETELY typical. Wait, that means I *do* fit in!

I just went and read the original paper. It was also interesting to read about the different kinds of studies they were looking at. Many of them were clinical trials, where they randomly assigned people to one diet or another. Others were just looking at people who on their own had either elected to diet or not.

I was curious, given your discussion of “lifestyle change” proponents, how researcher define dieting. As far as I can tell they look for behaviors like participating in weight loss groups, eating
low-calorie diet foods, eating fewer carbohydrates, and calorie restriction. Obviously some of those “lifestyle changes” you mention are included in that list, and were not found to lead to sustained weight loss either.

Regarding the proposed follow-up study… they’re not going to try to find people who have achieved sustained weight loss. They’re calling for studies that take a group of people, and randomly have some of them go on exercise programs and some not. And see what happens. Apparently there aren’t many studies like that.

I was curious to see if ANYONE in their sample population experienced sustained weight loss. A google scholar search pulls up this article which seems to indicate that, but they mostly are pretty physically active, they are mostly all doing something purposeful with their diet, and they mostly had some kind of “triggering event”.

I don’t know what all of this means, but I thought I’d at least share the links in case others are interested.

I’ve been putting the hard work into changing my habits for two years, slowly getting healthier, loosing weight, and being thrilled by the benefits. Your post depresses me horribly. I rather wish I hadn’t found your blog.

Louise, one way not to be depressed about it: if you’re getting healthier and feeling better, that is an awesome thing in and of itself! You can totally feel happy about that without staking that happiness on how thin you are/will be.

Plus, that way you actually get to appreciate your healthiness and good feelings. If you’re too focused on weight loss, on days when the scale goes up you feel crappy — even if you should be feeling nourished by your healthy foods and energized by your workouts. If you stop measuring your success and self-worth by numbers, you get to enjoy your real successes a lot more.

I get depressed by this too. I hate to mention it here in a space like this, which is nicely free of the loss-is-good mentality I am trying to fight, but I lost a significant (though in reality not that large) amount of weight over the past two years. Mostly because I decided I was going to teach myself to run. I didn’t really change my eating habits (beyond stopping when full, not stuffed), but I got SERIOUSLY, DEPRESSINGLY, OBSESSIVELY anal about them.

On the days on which I concentrate on my habits – the fact that I can now run five miles, that I finished my first 5K in under 32 minutes, that my intense intervals are upwards of 7.5 mph – I feel great. When I concentrate on the visual results of those efforts, I feel like crap. Terrified that things will change, depressed that it matters, obsessive about food again.

Take the time, change the habits. Those are what matter. Think about how good eating (mostly) healthy and working out (when you’re not injured) makes you FEEL. It’s much better for you and more likely to lead to food and excercise being about life and health and not restriction, guilt, and anxiety.

There are days when I feel like despite my own story and despite the fact that I have never had to go through some of the horror stories I read, I NEED the sense of body image acceptance that the FA movement offers. I know in my head that the last piece that needs to fall into place before I stop feeling guilty every time I eat is to remove the fear of fat.

I find that terrifying. Sometimes I worry that if I accept that, my behavior will change. I think that’s why it’s so important to focus on one’s habits as their own ends, maybe.

Entangled, nope, I think that was a great comment. The diet talk I prohibit is the “Just do X and you’ll lose the weight, and you’ll feel better because you LOST WEIGHT!” Your comment, as I see it, was Health at Every Size talk. :)

And those feelings of fear — and even Louise’s depression at hearing that diets don’t work — are completely valid and understandable and not off limits. I’ve been there, like you wouldn’t believe. I think a LOT of us around here have been there. Developing a healthy relationship with both food and your body is a long, gradual process — and it’s hard work. Much harder work than dieting, imo.

I’m not trying to shut out people who aren’t all “Rah rah, I love my body!” Fuck, I don’t love my body 100%, every minute of every day. But since the point of this blog is to help people move toward loving their bodies, without dieting, I just don’t want to hear about people’s diets. Doing exercise and eating food that makes you feel good, and examining the feelings of fear and despair that come up when you think about actually trying to accept yourself without getting thin, are all important parts of the process.

I suppose I am a freak of nature as I lost 122 lbs more than 5 years ago and have kept it off..How? Good old sweat equity and a healthy eating plan.You are right..DIETS don’t work.To say diet is to imply it is only a temporary thing which we all know, the minute you go back to mindlessly shoveling food into your mouth, the weight will come back.You must be willing to make a lifestyle change.You do not have to cut out the food you enjoy to lose weight and keep it off, you just have to moderate how much of them you eat.

…the minute you go back to mindlessly shoveling food into your mouth, the weight will come back.

I guess if you’re a freak of nature, Susan, then the rest of us are simply mindless shovelers. Even those of us who have experienced disordered eating and must work very hard each day to ensure we don’t slip back into those habits. Mindless, indeed.

Yes, because the kind of “lifestyle changes” that result in substantial weight loss are not sustainable in the long term. When people severely restrict their calories they feel sick, miserable, run down, and are obsessed with food (I just spent a weekend with three people on Weight Watchers.. fucking torture) … of course they go back to normal eating habits. And you have a lot of nerve calling anybody a rude cow after accusing us of “mindlessly shoving food in our mouths”.

Susan “old eating and lifestyle habits” for most of us = “normal and not depressingly orthorexic” eating and lifestyle habits. The amount of exercise and/or food restriction required to lose weight, for a lot of people, are simply not sustainable over a lifetime. And that is why they go back to their old habits…not because, in this wonderfully accepting culture of ours, everyone SECRETLY LOVES BEING FAT.

I’m happy that you managed to lose weight and keep it off and (presumably) maintain your health in the process, Susan, but for most people, it doesn’t work that way. And not for lack of trying, or lack of willpower.

Of course, it could be a different Susan, but I’m guessing it’s the same one and she has a penchant for exaggeration/confabulation. And being a douche.

I totally guessed the same thing, but I just checked, and the IP and e-mail addies actually are different. Which doesn’t mean it’s necessarily NOT the same one, but it probably means there are two douchey Susans out there.

Wow, so glad I found this blog! I’m still stuck in the needing-to-be-thin-to-be-healthy thing, as well as the needing-to-be-thin-to-be-socially-acceptable thing. I do want to be healthy, of course, as do we all, but it’s hard for me to wrap my brain around the fact that that really doesn’t mean losing a lot of weight.

Susan “old eating and lifestyle habits” for most of us = “normal and not depressingly orthorexic” eating and lifestyle habits. The amount of exercise and/or food restriction required to lose weight, for a lot of people, are simply not sustainable over a lifetime. And that is why they go back to their old habits…not because, in this wonderfully accepting culture of ours, everyone SECRETLY LOVES BEING FAT.

I totally agree with that… and it is related to a question I have been pondering on for a while. Why do we believe that we should control a behavior like eating consciously?
We know that the ability to control things consciously is a very limited resource for humans. Fortunately we have the ability to process a lot of stuff unconsciously and in addition to that our body comes with a lot of control mechanisms to maintain homeostasis* – in fact there are some studies that support the idea that dieting (or “portion control” or whatever you want to call it) does lead to weight gain in the long term – possibly because you are overwriting control mechanisms in your body by not listening to natural hunger cues.**
That said, I do think that some food producers have figured out how to make our normally completely self-regulating body into craving some foods – and I do believe that those foods often tend to be quite bad for the human body. But not eating those foods does not lead to weight loss, although it might make you feel better in your body.

*I know, I know… a lot of people will argue that we evolved in an environment where food was always scare and therefore we all have the urge to put food into our mouth constantly when we can find it… or something like that. You know, I seriously doubt that. Our ancestors certainly did go through times of famine (as some people do even during the present day) but at least once people invented farming which was a loooong time ago I do not think that lack of food was the norm. Still, the “obesity epidemic” is supposedly a recent phenomenon, right?
**This also goes with my personal experience… I still struggle with a rather disordered relationship with food and while I cannot proof it I am very, very sure that one of the main factors in becoming eating disordered was being told to restrict my food intake from age of four or so onwards (and of course, my doctor did not call it a diet).

I don’t think its an obesity epidemic so much as a “holy fuck, I have to be thin and look like a stick” epidemic. Look at paintings from the past that show women that are thicker and lovely with their ample curves. We’re women, we’re supposed to have curves and not look like a bunch of featureless boys (thinks of the freudian aspects of that can of worms) moving on… They were the ideal, and I don’t think that was a bad thing.

Serena, I appreciate and agree with the idea that fat is not necessarily unattractive any more than it is necessarily unhealthy.

But we don’t insult or demean anyone’s bodies here. It’s not appropriate to talk about thin women as looking like “sticks” or “boys,” or to imply that their bodies are not as they are “supposed to” be.

This post really got to me. I’ve used the phrase, “diets don’t work, but lifestyle changes do” before, but I thought of it differently. I wasn’t suggesting that lifestyle changes will make you lose all the weight you want to lose (which I suppose is what weight watchers promotes). I meant that positive lifestyle changes (such as eating good food and appropriate portion sizes all the time, rather than in temporary spurts, exercising regularly, and paying attention to your habits and changes in your body so that you can find a pattern that keeps you feeling your best at all times) will make you healthier (which may or may not change your weight, but will give you the health benefits, which are what you really need). In other words, that phrase meant that I shouldn’t focus on being a certain weight, but on being healthy, and living in my own personal healthy range, and everything else would fall into place.

If that’s not how other people take it, I guess I should stop saying that…

I meant that positive lifestyle changes (such as eating good food and appropriate portion sizes all the time, rather than in temporary spurts, exercising regularly, and paying attention to your habits and changes in your body so that you can find a pattern that keeps you feeling your best at all times) will make you healthier (which may or may not change your weight, but will give you the health benefits, which are what you really need). In other words, that phrase meant that I shouldn’t focus on being a certain weight, but on being healthy, and living in my own personal healthy range, and everything else would fall into place.

Chica, we’re totally behind all that, but that’s called “Health at Every Size.” When people say “permanent lifestyle changes work,” they usually mean “to make you lose weight and keep it off”–not to become healthier regardless of weight.

There is nothing more frustrating (OK, to me) than maintaining a “lifestyle” change for four years and not maintaining a weight loss. DH and I have been low-carbing for four years (which we started because of his cholesterol problem). I lost 35 pounds within six months. W00T! Over the next 3.5 years I gained back nearly every ounce. Do we still low-carb? Yes! Strenuously! Strictly! Assiduously! And we still like it — cholestrol is the envy of our doctors, we sleep better, no more prescription-strength pain of heartburn, just better health over all. But weight loss? Not so much.
Also, Kate, though I love you with the white hot passion of a thousand suns, could you please do me a tremendous favour (oh yeah, I’m Canadian) and make sure your links open in another window. I’m too lazy to click back when I follow a link within your articles.
Thanks.

I’ve read this post a few times by now, and usually I tend to believe all of it without a second thought. However, from time to time I have trouble believing in the setpoint theory because it just doesn’t explain why some people get fat suddenly. Like my mother, who was already fully grown at the time, not ill, and it’s not like it happened directly after a pregnancy or something. One could argue that she was subconsciously restricting herself before, but it didn’t look like it. Strangely enough, the weight gain magically stopped while she was going on and off diets, which technically should have made her even fatter. This seems to happen to many other people, too – they can’t all be freaks of nature, can they? This topic is so confusing. :(

Also, sometimes people will suddenly jump at me from hidden dark corners of the internet and I’ll get told six times in a row that it is indeed possible to lose a lot of weight and keep it off for more than five years because they’ve been there and done that. If there’s so many of those guys at once, I just don’t know what to believe anymore.

I suppose it’s not that important because I can at least accept that obesity doesn’t kill, but I’d like to understand the “diets don’t work” part, too … because it’s the best argument EVER.

[…] I would have expected this kind of “pay no attention to bad facts that might depress you” rhetoric in a regular diet book, but in most other respects this book is “different” and more scientifically rigorous, so this glossing over stuck out like a sore thumb. What I suspect happened was, Nelson looked for studies showing sufficiently rosy outcomes from dieting, failed to find them, and decided instead to make generalized statements because she considered it more important that dieters not be “discouraged” than that they know the actual truth, which is that nobody has yet found a way to make fat people permanently thin. […]

[…] I figure it’s at least as reliable a plan as “calories in/calories out”. It’s as simple as that. I may look for research funding to determine if my plan can ever be as effective, in the long term, as dieting. […]

I lost over around 50 pounds after shifting from an inactive lifestyle full of takeout and snacks to an active lifestyle full of groceries, home-made lunches and replacing juice / flavoured drinks with water (and I still have takeout a couple of times a week too). So far, at the three-and-a-half year mark, I feel fantastic and healthy, and it’s not coming back, any of it. (Exception – I always seem to gain a couple of kilos around Easter and Christmas, the cause there should be obvious; said kilos always drop back off as soon as I return to my now-normal eating habits.)

However, I’m not one of those people who is going to storm in here and claim that because -I- am not regaining weight, I’m living proof that lifestyle change leads to weight loss for everyone. And as I haven’t hit the five-year mark yet there’s always the possibility it’ll come back.

However, I think a healthy lifestyle change (not a diet, but simply chosing to put healthy foods into your body and lead an active life) leads to a NATURAL weight for everyone. And that differs from person to person. I’m 5’3 and my natural weight point seems to sit around 57 kilograms (125 pounds). Sometimes I lose a couple, sometimes I gain a couple, but my ‘cruising speed’ is 57. I’m guessing – hoping really, as I feel so good – that this is my natural healthy weight. I’m guessing that for many other women, their natural weight is higher and therefore that’s what their body keeps trying to return to.

From what little I’ve seen of the rest of your blog so far, you seem to be saying the same thing with your “health at any size” idea.

What I’m wondering is this: when you say that nobody loses weight without packing it back on after five years, do you think that will apply to me too?

I ask because I know for a fact that my weight before was caused by years of truly, unnecessarily awful eating habits. I was a big girl and I don’t think I was supposed to be.

I’ve learned to pay attention to my body, and what I notice is that I’m the most energetic and healthy around 57 kilos. I felt like crap all the time when I was bigger – tired, unmotivated – which is part of the reason I think I’m actually at my natural size -now-. Am I likely to suddenly gain 20+ pounds in the next year and a half?

Because I’ll be honest, I don’t want to. It’s not like I’m stick-thin now, I’m quite curvy; my concern is not about appearence, it’s about what feels great. (Plus at this weight I’m light and fleet enough to bolt for the ferry whenever I’m running late, which is a definite advantage for a disorganised gal like me!)

In conclusion: I love my body right now, absolutely love it. I’ve never felt more at home in my skin, and I don’t want to lose this. Are you saying it’s going to happen, for sure?

Hi, I’m a new reader and have been really fascinated to discover the world of FA blogging (I blog on religion). I hardly know where to jump in – so maybe I could just share my story for now?

I was on the thin side of ‘normal’ (low healthy BMI I guess, or however we’re measuring ‘normal’) until college, when I gained 35 pounds and a fun habit of binge eating. I was horrified, embarrassed, desperate to be rid of the weight (not exactly living fat acceptance, eh?) and therefore tried all kinds of diets. For awhile I thought I was a carbohydrate addict, so I restricted carbs. It worked, of course, but it’s no way to live. Then I was convinced that it was a spiritual problem, so I did the ‘weigh down’ diet. It worked, sort of, but I was constantly wracked with guilt. Then I got really into running, and that helped some. So through all this maybe I lost 15 pounds, I don’t know, but I was still unhappy with my appearance and totally obsessed with food. It consumed my thoughts day and night. It sucked. Royally. And I hated my appearance. Natch.

Then I had my first real heartbreak, over 7 years ago. I completely lost my appetite, and, accordingly, a ton of weight. I eventually regained my appetite, but (and I really don’t know how to explain this), the disordered eating patterns / obsessions never returned. I haven’t binged in 8 or more years and, now in my thirties, I am back at my HS weight.

I don’t know how to understand, or explain, what happened to me physiologically. I guess dieting didn’t work? Except I did lose a bit of weight through the various diets I tried, and then lost it all through a weird emotional upheaval that seemed to reset all of my internal systems. What happened to my ‘set point’ during those years? Why have I returned to a set point of my teenage years, when most teenage bodies aren’t fully mature and it’s totally normal to weight more than that as an adult? What made my binging urges go away?

I guess I have more questions than answers right now. I will continue to read and learn… :)

[…] low sugar ice cream. She walks away laughing and I feel emotionally drained. You see, this is why diets don’t work. And in my case….. One: There was no discernable difference in her shape. Two: She was a […]

Note: I am so sorry for the length of this comment. I started writing and things I’ve never talked about before came out, because I need to tell them to someone. I’m also sorry if this seems at all off-topic. I really think this stuff is all intertwined and connected to the stuff in this post.

I’ve always been “fat,” primarily because until I was in my 20s no doctor bothered to tell me that my frame was so big that if I had 0% (not a typo) body fat, I would be ten pounds into the “normal range” for my height. I was bulemic in my early teens, and yet no one bothered to tell me that no matter what I did, I would never even look like most other girls do, much less like the ideal I was pursuing. So recently, when I saw a trans person on tv (my sister was watching it) say ‘I was born in the wrong body,’ I thought, “OMG there are words for that feeling I have all the time.” My body feels so unfeminine to me because of its size, regardless of how ostensibly fat I am. Having a hard time at normal stores at my thinnest, and still weighing 1.5-2 times as much as my best friends, was not fun. Unlike most women, I can’t take much refuge in shoes, either, since most stores don’t even carry my size.

I have also never really been capable of eating until satiety and stopping. I only feel empty or sickeningly full. I am aware that most people (fat or thin) do not have this problem; that’s why it’s called disordered. In college I got to a more ok stance on the bod; it moved the way I wanted it to it allowed me to get freaky ,etc. At some point in here, I thought it would be a good idea to start a diet (WW) and I lost 20 lbs. (That 20 lbs is really important to the evil anti-fat twin inside my head because when I get to 190 or so I can fit into a 14, so I could sometimes shop in normal stores.) Then I hit a major depressive episode. (Does anyone else think it’s odd that I started losing weight and then got depressed? My first episode, when I was 13, had also started upon ‘dieting success.’ I can’t find them now, but I found a couple of articles saying: ‘A certain percentage of people become depressed after losing weight. This might be bad, but it’s such a small percentage…Aw, forget it.. Screw the fatties!’ A couple of years and dozens of medications later, I found something that sort-of worked (sort of working vs. not at all working might be the difference between life and death with major depression), with one major drawback; I started to gain weight–fast. That happens to so few people who take these meds that the nurse in the gyno’s office didn’t believe me when I told her my shrink said the medicine might be causing it. (This was after she looked at my chart and went “Whoa, 70 pounds in under a year?” Omg! Thanks so much, I didn’t notice it.) Overall, I have gained over 100 lbs and counting in one year–the vast majority of it in about six months. I had finally almost reached some measure of fat (not body, I still need to work on the fact that I have a Honda Element frame and I will never be a Smart Car) acceptance at my ‘normal’ weight, but now I have to deal with moving in my body feeling like I am driving someone else’s H2 Hummer instead of my Element and looking at all the new parts of me that got bigger. (Back hump, anyone? And yes, I tested for Cushings and came back negative,) What’s really upsetting is that my body is covered in stretch marks (I call them my racing stripes,) to the point where my arms look so scarred I don’t feel comfortable wearing a shirt with sleeves shorter than elbow length. And with all that, remember I’m still depressed, plus I have no sex drive (I used to be a 2-3 times a day girl, now my body can’t even do that) and huge sugar cravings from the meds.

Liking my body is definitely not happening. My problem right now is that for HAES to mean something, you have to actually be able to move toward the H. The fatigue is so bad I can barely walk the dog a couple blocks, so most exercise is out, and I eat all my veggies already. I’m having trouble accepting a body that is covered (no, really) with huge red lines, continues to increase in size even now, and makes everything suck. I just wish it would go away. And then I feel bad for internalizing the patriarchy and allowing it to continue.

My in-laws retired almost ten years ago, gradually lost a lot of weight, and kept it off. The key is, they retired. They have all the time in the world to cook filling, semi-healthy meals and enough money to afford a gym membership.

If someone was willing to toss a few million bucks in the bank for me, so I could retire and devote plenty of time to cooking and exercise, I bet I could slim down. I was far thinner when I was single in college, and could walk everywhere I needed to go and exercise a few hours a day (plus get extra sleep to deal with the fatigue from exercise).

But those of us who work for a living – and that definitely includes people who work at home with their kids – don’t have the luxury of that much free time. That’s life, and we need to forgive ourselves for it, and the world needs to accept us for it.

Lila, you do exhibit multiple symptoms of Cushing’s. It’s very possible it wasn’t caught by a single test. I would recommend talking to an endocrinologist. There are people who have it who fail to test positively:

[…] how to take care of themselves, it’s probably Dr. Regina Benjamin. Maybe she just understands the overwhelming failure rate of diets. Maybe she just understands that eating habits and physical activity are oftentimes not related to […]

[…] I know that’s what you want to hear. No really, I mean it. But I have to tell you – I’ve been where you are and so have many, many other fatties. I’ve been on the down-side of weight loss and felt that smug superiority, happily professing to […]

I have to say, I have never been more SICK and EXHAUSTED and generally SHITTY-FEELING as when I was at my thinnest– on a “lifestyle change”. I went back to eating healthily, with a few occasional treats, a good balanced diet, and I gained 10 pounds, but suddenly I could ::gasp:: walk up the stairs without panting! Play tennis! Make it through the day without falling asleep! My god– it’s almost like I was HEALTHY while I was 10 pounds heavier (technically in the “overweight” category of the BMI scale)! Imagine that!

Did you also develop breasts and secondary sex characteristics earlier than your peers? This is another possible symptom of PCOS.

My biggest suggestion is that you take a look at a book called “The Savvy Woman’s Guide to PCOS” and read a little bit about the issues that come on with PCOS.

I am currently taking metformin to deal with the testosterone/insulin levels that are screwy because of the disorder. It helps to regulate my sugar cravings (imagine that, I can eat a cookie or two without eating the whole box because of the horrible cravings that make me feel like I am DYING if I don’t eat another cookie). I’ve also switched to a mostly-low glycemic index diet, and do my best to balance out all my carbohydrates and sugars with a protein of some sort. I’m not perfect, but I was able to get pregnant after being told I was infertile and I lost a good amount of weight during the pregnancy while being perfectly healthy (my hormones seemed to “normalize” while pregnant).

I’m now about 20-30 pounds lighter after giving birth than when I started the pregnancy (and while I know that this is horrible, I never felt so good about myself under the approving eyes of my doctors and family members who saw me look “so good” while pregnant simply because of the weight loss). Even though I was exercising just as much as I was before the weight loss, I suddenly got attention for it and people seemed to believe me when I told them what I was doing “right” to be healthy, even though I was doing the same stuff before when I was fatter.

Now, I feel a lot more active and comfortable in my skin, but I also know that I have large problems with body dysmorphia. I look in the mirror and see something that is far larger than I (think) I really am. It affects my pictures too, because I used to see pictures of myself as a teen and thought they were horribly fat, but now I look at them and see that I was normal sized.

I am still trying to accept myself, and now I’m so afraid about my own daughter. She’s perfectly sized (I had borderline gestational diabetes that I controlled with diet/exercise alone, but that was more due to my PCOS than my eating habits and lifestyle), but she’s got a tall frame (20 inches at birth, and only 6lbs/13oz ). Everyone always says “wow, she’s so big!” and I keep trying to correct them by saying, “No, she’s TALL, tall not big.” because all I can think of is that I don’t want people thinking that I (as a fat mom) am some kind of horrible person who is “abusing” her child by making her fat.

I know it’s going to get worse when she gets older. Every stray pound or two is going to be looked at like a black mark on my parenting abilities, and my daughter is going to pick up on it and I hope that it doesn’t lead her to develop an eating disorder. And I hope that this child will be normal sized as a little one (like my husband and I were before we gained weight in teenage years) because nothing is worse than being the fattest kid in class, because even if you’re autistic or have ADHD, you have an “excuse” for your condition.

Oh, and can I take a second to mention how horribly degraded it is that the “obesity epidemic” assholes are making type 2 diabetics look like heathens who brought it on themselves? There are ways to “increase” your genetic propensity to get diabetes, but there is no way to “make” yourself get diabetes. Many kids with type 1 or type 2 diabetes are being made fun of because they are being told that it is “their fault” that they are sick. They are being made fun of and treated horribly because popular culture is using diabetes as the ultimate “health reason” as to why obesity is “bad”. But there is so much evidence that DIABETES MAKES YOU FAT, not the other way around. And then adding INSULIN into the equation CAUSES YOU TO GAIN MORE WEIGHT.

Even smokers who get lung cancer don’t get treated as badly as a fat person with diabetes. I can’t understand why, except to think that cancer seems to make you look “thin” if you are getting chemo. My friend’s aunt had lung cancer and was absolutely ecstatic when the chemo caused her to lose over a hundred pounds, even though she looked like a skeleton and was obviously unhealthy. To her, it was more important to be at the size she was in high school than to be able to live pain free and actually breathe.

My question is this: why is it so much “better” for a fat person to be thinner, or to lose weight, if the end result is that doing it makes them unhealthy and feel like crap? Why is weight loss without any regard to health MORE IMPORTANT than health at any size?

Even though I know that I have gained some weight back and keep telling myself that it’s because my breasts are full of milk because of breastfeeding (I’m like 52 inches around the bust now, but they don’t seem to make anything in my cup size that also fits my frame and shoulders), it still doesn’t stop me from feeling full of shame when I see my doctors look at me like I’ve been doing something bad. Also, their gasps of surprise when my pulse and blood pressure are normal, “even though you’re so big!”

I don’t want to feel like crap every time I look at my weight, (I just had a baby, for goodness sake, and should cut myself some slack as it is for the way I look), but it’s just something that has been so ingrained in me, that I almost want to scream every time I hear someone give me the “calories in/calories out” routine or the “you’re killing yourself/hurting US and the rest of the family by being fat” lecture.

*sigh*

Just gotta take it day by day. Immersing myself in my “mom role” helps a lot, so I don’t need to make myself so conscious of the fact that I totally fail at being sexy and attractive in a conventional way.

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I love your website, which I’ve just discovered, but this entry dismayed me. I have been fat all my life. I was at around 220 in high school, which was, I realize only in retrospect, a wonderful weight for my tall, muscular body. I was in my prime. Of course, I hated myself at the time and was obsessed with becoming thin. Now I feel infinitely more comfortable in my own skin. Over the years, my feminism and fat acceptance grew, but so did my binge-eating. Ten years after high school, I’m at 330lbs. I also have high blood sugar, high blood pressure, and borderline diabetes, which developed progressively in the last ten years. Sure, my genetic predisposition to diabetes must have contributed to my weight-gain, but the fact that I frequently consume 5-6000 calories a day must also have been a factor.

I do not want to lose weight because I want to look different. After many years of hard work, I’ve learned to accept my body and love it for the pleasure it gives me. I’m an academic and a feminist, and feminism has played a huge role in helping me to see disciplinary power at work in the barrage of images and advertisements we face every time we turn on the t.v. or walk out the door. I never thought I’d have a sexually fulfilling relationship, but I do. My life is very full and very rich.

I have always hated dieting; I’ve never been able to do it for very long. Binging relieves my anxiety and is an expression of several emotional issues. I’ve been in therapy for a long time. While my self-awareness has increased dramatically, my binging has only decreased nominally. I’m still working on it.

The thing is, I want to lose weight now. Not a hundred pounds. Maybe 50. Maybe 30. Anything that I can accomplish which will lower my blood sugar and blood pressure would be wonderful. (My joints ache, I have orthopedic issues that are exacerbated by my weight, but they hurt the same when I was at 250-290, so maybe it’s not at all in my power to resolve that.) My blood sugar, however, goes down when I exercise, when I eat less carbs, when I lose a little weight. (I’ve lost 15 lbs and gained back 5 in the past year.) I’ve seen how small weight losses favorably affect my blood sugar and my blood pressure. I do NOT think this is the case for all fat people, but it is for me.

I know diets don’t work, but I hope that if I stop binging, my weight will go down and have positive health benefits. I don’t know if I can really stop binging. I know that my size is a factor of genetics. I am, have always been, and will always be a fat woman. I know that diets, whatever you call them, don’t work in the long-term. But I want to lose weight because I want to lower my blood pressure and my blood sugar. I want to delay or prevent the onset of full-blown diabetes. I don’t want to diet, but I do want to stop binging, and that’s the equivalent of dieting for me.

This post dismayed me because it reminded me of studies I’ve read before. The ones that say that nobody really ever loses weight and keeps it off. The five years is crucial. Can I be an outlier? I feel even more discouraged after reading this post than I generally do. It’s been a long journey from hating myself, to accepting myself and hating dieting, to realizing that my weight is actually having a negative effect on my own health. I hate the obesity myths as much as anyone with a brain, and I’m aware of how science is complicit with dominant ideologies. But the numbers don’t seem to lie in my case.

Mel, have you ever been treated for binge eating disorder? Recovering from an eating disorder (whether it involves too much or too little food for your body and mind) is not the same as doing a weight-loss diet.

I hope you stick around and keep reading the archives; you’re not alone.

I’m a family physician who weighs 328 pounds at 74.5 inches. I am very fat (was fatter at 385 pounds 1.5 years ago).

I just returned from the The Obesity Society’s 2009 meeting in Washington DC. I was hoping to find something to help me and my patient’s, but there was nothing. Not a single drug trial showed anything promising. The best weight loss was in the 5% to 10% range and if the study was carried out beyond a year weight regain appeared. The studies mainly involved psychoactive drugs and anticonvulsants.

Studies involving exercise and behavioral modification involved unrealistic amounts of exercise in my opinion and the results were worse than with the medications.

There was one lecture though was very interesting. It was titled: Fitness is More Important Than Fatness in Determining Health and Disease Risks. The lecturer showed clearly that obesity is not an independent risk factor for mortality. In fact, thin unfit people were 5 times more likely to die than even very fat fit people. Though his research was backed by strong data, the lecturer was challenged aggressively and it was clear his findings were not popular. For anyone interested it seems weight lifting may be a very good type of exercise for us and one of the researchers felt it was the oxidative capacity of skeletal muscle that confers the benefits from exercise.

Since the conference ended I have been considering stopping my weight loss medications (Bupropion and Topamax) and simply exercising and eating healthy and accepting my weight whatever it might be. I may encourage my patients to do the same. The only exception might be the very rare patient that is so obese that they simply can no longer function adequately (yes, they do exist and in some cases cannot walk and have to have a tracheostomy in order to breath).

I have studied obesity for for over 10 years now and I think you conclusions are correct. I suppose this is blasphemy for one in my profession. I think the main reason for classifying obesity as a disease is so certain (not all) obesity researchers and pharmaceutical companies can make money from government grants on future drugs.

Incidentally, I have endeavored for several years now to never assume one of my fat patient’s problems was due to their weight. To be honest, even as a fellow fat person it is still a prejudice I have to fight since it if so ingrained into my education. I caution my colleagues against it too.

In terms of weight lifting for us fatties, I’ve found that slow movement strength training (marketed as ‘Slow Burn’, ‘Power of 10’ and ‘SuperSlow’) is by far the easiest on my joints. Just ignore the diet recommendations each one carries. I found the ‘Power of 10’ book for $1.50 at a used book store, and of course if you’re lucky you may find them at your library. I’m one of the “you’re not fat” crowd, with a BMI 32, and I have no knee pain, very little back pain, and the ability to traverse a few flights of stairs without needing to catch my breath. Weight lifting twice a week for about 20 minutes is the only exercise I do. Just whatever you do, don’t hold your breath while you lift the weights. That can make your blood pressure spike.

Thanks for the tip Mike. I have researched the super slow weight lifting (high intensity) style and I am going to try it. I will work on the large muscle groups and start with 1 workout per week going to muscle failure with each workout.

Good luck. As always, please take it really, really easy at first. I know from experience the strong temptation to push yourself, but really your first three or four workouts should feel like a waste of time. I think I had better results with twice a week or three times every two weeks, but I was never very scientific about it.

[…] this (see below), but sometimes I just don’t have the time/energy to say “you know, diets don’t work” and prepare myself for the inevitable defensiveness that seems to come with being told this […]